Liver Center | Referrals & Transfers

Physician Resources

Referrals
To refer a patient to the Hartford Hospital Comprehensive Liver Center complete the on-line referral form or call 860.972.4262.

Forms
The following forms are available for download (click here for more forms):

Ambulatory Record
Authorization to Disclose Health Information (HH) (English)
Authorization to Disclose Health Information (HH) (Spanish)
Consent for Radiation Therapy (English)
Consent for Radiation Therapy (Spanish)
Informed Consent (English)
Informed Consent (Spanish)
Informed Consent for Liver Transplant Evaluation Process (English)
Informed Consent for Liver Transplant Evaluation Process (Spanish)
GI Pre-Procedure Orders
Physician's Order Form
Pre-Op Ambulatory Surgery
Imaging Center Requisition

Comprehensive Liver Center at Hartford Hospital

Medical Office Building
85 Seymour Street
Suite 324
Hartford, CT 06106
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Liver Center | Referrals & Transfers

Physician Resources

Comprehensive Liver Center at Hartford Hospital

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Find a Hepatology Specialist

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